Unit 6 Week 3: Alzheimer's Disease Flashcards
what are the stages of Alzheimers
pre clinical
early/mild
middle/ moderate
late/severe
these stages may overlap, each patient progresses through them differently
early stages
main symptoms is memory lapses
forget recent conversations/events, misplacing items, forgetting names, struggling to think of right word, ask questions repetitively, poor judgement, harder to make decisions, less flexible
middle stages
memory problems increase
may not remember names of family
usually need help with daily living
other symptoms may also develop: increasing confusion and disorientation, obsessive/repetitive/impulsive behaviour, speech/language problems, disturbed sleep
late stages
hallucinations and delusions worsen
increasingly agitated
dysphagia
sometimes severe weight loss
urinary incontinence/ bowel incontinence
progressive stages
to begin with only one area of the brain is affected
as dementia develops, more areas affected, symptoms worsen
original affected areas also worsen during this time
can be affected by several factors: age of onset (early is more likely to progress quickly), types of dementia have different rates of progression, co-morbidities
risk factors for Alzheimers
physical inactivity
smoking
unhealthy diets/ obesity
social isolation
alcohol
hypertension
diabetes
hypercholesterolemia
genetic mutations in APP (amyloid precursor protein)
cognitive imactivity
depression, can cause inflammation medication use
older age
females
investigations for alzheimers
ask patient/ family/ friend questions
memory/ personality test
blood/urine tests for alternative cause of symptoms
performs brain scans, PET scans, MRI, computed tomography
AD that looks amount of beta amyloid and Apo E in blood
why is an early diagnosis important
can help diagnoses other causes of memory problems
plan for future, financial and legal matters, learn living agreements, can provide opportunities to participate in clinical trials/ other research studies
what are the different types of dementia
alzheimers
vascular
Lewy body
frontotemporal
mixed
alzheimers
most common type
no cure but medicine can slow progression
symptoms: difficulty remembering recent events (often retaining good memory for past events), poor concentration, difficulty reorganising people or objects, poor organisational skills, confusion
vascular dementia
second most common type
occurs if oxygen supply to the brain is reduced because of narrowing or blockage of blood vessels
causes some brain cells to become damaged or die
symptoms: language, reading, writing, sudden changes in mood, walking, bladder control
Lewy body dementia
progressive condition affecting movement and motor control
memory loss is less affected
symptoms: prone to falls, sudden bouts of confusion, tremors, trouble swallowing, experience, disrupted sleep patterns due to intense dreams/ nightmares and auditory hallucinations
frontotemporal dementia
affects fontal lobes of the brain, controls behaviour, learning, personality and emotions
difficult to diagnose as sometimes complicated with depression, stress, anxiety, psychosis, OCD
can cause inappropriate social behaviour and lack of inhibitions
eating patterns can be affected
mixed dementia
when someone has more than one type of dementia and a mixture of the symptoms
possible to have 2 types of dementia at once
most commonly AD and vascular dementia
differential diagnosis for dementia
delirium
depression
drugs
normal age-associated memory changes
mild cognitive impairment
complications
alzheimers is life-limiting and people normally die from another cause:
aspiration
chest infections
lack of appetite and difficulty eating
how to break bad news
SPIKES
setting up
patients perception
invitation, accept patients
knowledge and information
emotions and empathy
strategy, summary and support
epidemiology
55 million globally
rise to 139 million expected by 2050
alzheimers account for 60-70% of dementia cases
treatment and management strategies
memory clinic
medication alzheimers
medication non alzheimers
medication challenging behaviour
coping strategies
non pharmacological treatment
end of life medication
anticipatory prescribing
palliative care
support groups
care homes
specialist care homes
memory clinic
specialist service where people with memory loss are assessed and diagnosed
ran by: neurophysiologists and nurse specialists
complete memory clinic test to assess all lobes of the brain, screening of brain, Addenbrookes cognitive examination, may organise MRI
may return months later to assess progression
alzheimers medication
acetylcholinesterase inhibitors
memantine
acetylcholinesterase inhibitors
donepezil, rivastigmine, galantamine
mechanism of action:
selectively and reversibly inhibits acetylcholinesterase enzyme, enhances cholinergic transmission OR involved in oppositio of glutamate-induced excitatory transmission via down regulation of amyloid proteins
side effects: aggression, decreased appetite, syncope, hyper salivation, bradycardia
memantine
mechanism of action:
uncompetitive (open-channel) NMDA receptor antagonist, preventing glutamate action on the receptor
has a preference for NMDA receptor-operated cation channels
side effects: impaired balance, confusion, embolism and thrombosis, hallucinations, heart failure
donepezil or rivastigmine
Lewy bodies (mild/moderate)
consider for severe DwLB
galantamine
Lewy bodies (mild/moderate) if above aren’t tolerated
memantine
Lewy bodies if AChE inhibitors not tolerated
AChE/memantine
vascular with suspected comorbid alzheimers, parkinsons or Lewy bodies
when shouldn’t you use AChE/ memantine
for frontotemporal dementia
medications for challenging behaviour
try coping strategies first
antipsychotics for extreme distress/aggression e.g. risperidone, haloperidol
antidepressants if depression is a cause of anxiety
alternative therapies= gingo biloba, cucumin, coconut oil
coping strategies
find triggers
keep active
provide reassurance
quiet calming environment
activities that give pleasure/ confidence (dance/listening to music)
therapies: animals/music/massages
non-pharmacological
cognitive stimulation therapy, CST
cognitive rehabilitation
reminiscence and life story work
pain in palliative care
opioids: morphine, diamorphine, oxycodone, affentanil
breathlessness end of life medication
midazolam or an opioid
anxiety end of life medication
midazolam
delirium/ agitation end of life medication
haloperidol, levomepromazine
midazolam, phenobarbital
nausea and vomiting end of life medication
cyclizine, metoclopramide, haloperidol, levomepromazine
noisy chest secretions end of life medication
hyoscine hydrobromide
glycopyrronium
anticipatory prescribing
ensuring someone has access to medicines they’ll need if they develop distressing symptoms at home/care home
symptoms required: pain, anxiety and distress, delirium, breathlessness, agitation, nausea and vomiting, noisy chest secretions
palliative care
incurable illness
makes you as comfortable as possible by managing pain and other distressing symptoms
last months/ years of life
live as well as possible until you die, die with dignity
Age UK
have some dementia specific classes such as singing for the brain, dance for dementia, art for dementia, memory cafes, trips and outings
singing for the brain
brings dementia patients together by singing songs they know and love
care homes
2 types
residential and nursing
residential care homes
provide personal care
help with washing, dressing, medications and going to the toilet
nursing care homes
personal care
24 hour care form qualified nurses
specialist dementia care homes
simple building plans
coloured doors specific to areas to recognise where they are
easy access to all parts of the building
proper signage
dementia friendly furnishings
sensory gardens
gradual changing lighting
communicating with dementia patients
VALID
reminiscence therapy
PEARL
SPARK
VALID
validation
acknowledge feelings
reminiscence therapy
use memories to stimulate conversations/ happiness
PEARL
provide simple clear concise information
empathise
active listening
respect
listen
SPARK
simplifying instructions
prepare environment
addressing emotions
repeat information
keep calm
practical strategies to help someone with dementia
notes/ prompts
preparing advanced decisions
social strategies to help someone with dementia
family help, support/ activity groups
emotional strategies to help someone with dementia
humour
focus
health improvement strategies to help someone with dementia
exercise
healthier diet
support groups for dementia
Age UK
carers UK
dementia UK
relate
psychological impact of dementia
grief
loss
anger
relief
fear
disbelief
irritability
lack of confidence
lack of self esteem
rapid mood changes
advance care plans
outline patients preferences for their. future medical care if they can no longer have mental capacity to make their own decisions
voluntary process
may include: advance decision to refuse treatment, lasting power of attorney, context specific treatment recommendations
not legally binding but the ADRT and LPA are
prepared with help of HCP, reviewed and updated regularly
who is given an advance care plan
deteriorating health
declining functional status
key transitions in health
major surgeries/ high risk treatments
do not attempt resuscitation
when individual is in respiratory or cardiac arrest
decision is made by an individual, Dr or LPA
issued and signed by the Dr when CPR is unlikely to be successful
can be changed at any time
other treatments are still allowed
not legally binding but the ADRT is
what does CPR involve
chest compressions
defibrillation
artificial ventilation
IV Meds
lasting power of attorney
legal document
allows an individual to appoint someone they trust to make decisions on their behalf if they’re unable to
can have: health and welfare LPA and property and financial LPA
must be 18+ and have mental capacity
can have more than 1
costs £82 to register
can have decision restrictions
generic pathophysiology of dementia
majority other than vascular are caused by an accumulation of naive proteins in the brain
not fully understood
alzheimers pathophysiology
widespread atrophy of cortex
deposition of amyloid plaques
tangles of hyperphosphorylated tau protein in neurones
contribute to degeneration
Lewy body pathophysiology
intracellular acucmulation of leeway bodies
which are insoluble aggregates of alpha-synuclein in neurons
mainly cortex
frontotemporal pathophysiology
deposition of ubiquinated TDP-43
hyperphosphorylated tau proteins in frontal and temporal lobes
leads to dementia, early personality/ behavioural changes, aphasia
vascular dementia pathophysiology
ischaemic injury to the brain e.g. stroke
leads to permanent neuronal death
effect of dementia on the hippocampus
often involved and contributes to memory loss
cells in this region are normally first damaged in alzheimers, resulting in memory loss
changes in hippocampal volume (reduction) are seen with common ageing patterns but exacerbated in alzheimers
anatomy of the brainstem
cerebral peduncles
contains axons of upper motor neurons
descends from primary motor Cortex to spinal
olives
external protrusions caused by underlying nuclei
inferior olivary nuclei regulate motor co-ordination and learning
pyramids
bilateral protrusions caused by underlying corticospinal tracts
decussation where fibres swap sides, fibres run transversally between pyramids
superior middle and inferior cerebellar peduncles
bilateral axon tracts that connect cerebellum and pons
superior colliculi
involved in attention
inferior colliculi
involved in auditory processing
cross sections of the brain
cerebral aqueducts
channel connecting 3rd and 4th ventricle
corticospinal tracts
axon tracts involved in voluntary movement
run bilaterally down ventral pons
continuous with cerebral peduncles of midbrain
thalamus
sits on both sides of the 3rd ventricle
passes through 3rd ventricle by inter thalamic adhesion
label the image
- caudate nucleus
- caudate nucleus
- putamen
- thalamus
- caudate nucleus
- putamen
- globus pallidus
- thalamus
